Provider Demographics
NPI:1447296009
Name:BROOME, JOSEPH KEVIN (DC)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:KEVIN
Last Name:BROOME
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 243
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29622-0243
Mailing Address - Country:US
Mailing Address - Phone:864-760-0250
Mailing Address - Fax:864-760-0252
Practice Address - Street 1:110 MIRACLE MILE DR
Practice Address - Street 2:SUITE H
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-1332
Practice Address - Country:US
Practice Address - Phone:864-760-0250
Practice Address - Fax:864-760-0252
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3302111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor